OB-GYNs should respect the right of pregnant women to refuse recommended treatment, even if the lack of treatment is detrimental to the fetus, according to a committee opinion from the American College of Obstetricians and Gynecologists (ACOG), MedPage Today reports.
Members of ACOG's Committee on Ethics published the opinion in Obstetrics and Gynecology.
In the opinion, the authors affirmed that an OB-GYN treating a pregnant woman has a primary obligation to treat the woman, not the fetus, and the woman has the right to refuse treatment. Specifically, the authors wrote that while OG-GYNs have "beneficence-based motivations towards the fetus of a woman who presents for obstetric care," they have "a beneficence-based obligationto the pregnant woman who is the patient."
For example, according to the opinion, an OB-GYN might recommend that a woman with a condition that makes pregnancy life-threatening, such as severe cardiopulmonary disease, have an abortion. Such a recommendation affirms the primacy of the woman as the OB-GYN's patient, not the fetus.
Co-author Mary Faith Marshall wrote in a statement, "This reinforces ACOG's longstanding support of a patient's right to consent to or refuse medical treatment, and the principle that pregnancy is not an exception to this fundamental right." She continued, "Respecting this right is vital to the patient's relationship with her physician, and prevents coercive interventions and incursions against bodily integrity, which are always ethically impermissible."
The authors also wrote that OB-GYNs should not force a patient to undergo a medical procedure, nor should they comply with court-ordered medical interventions that "violate their professional norms of conscience." The authors lower-income women, women of color and women whose first language is not English are more often subjected to court-ordered inventions, including mandated cesareans. Moreover, according to the authors, nearly one-third of lawsuits seeking court-ordered interventions are based on erroneous medical judgment. The authors added that court-ordered interventions also could discourage women from seeking care.
The authors stated, "Forced compliance -- the alternative to respecting a patient's refusal of treatment -- raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power differentials, and gender equality."
The authors advised OB-GYNs to instead offer "directive counseling." According to the authors, such an approach involves an OB-GYN providing the patient with his or her recommended course of action without issuing threats or attempting to force the patient to comply. The authors further recommended that an OB-GYN offering directive counseling do so with a team of medical professionals -- such as ethics consultants and staff in relevant medical fields -- and loved ones involved in the woman's care. The authors added that if a woman opts against recommended treatment and experiences an adverse outcome, the OB-GYN should continue providing support to the woman, including counseling if desired.
Committee Chair Sigal Klipstein said, "While such situations can cause distress to both the patient and her physician, it is imperative that the pregnant woman be supported and that her wishes be respected" (Walker, MedPage Today, 5/24).
